Zvose Uburusi Hazvina Kufanana
Kazhinji ndinokumbirwa kuti ndikurudzire zvandinofunga kuti ndiyo inonyanya kuora mwoyo. Mhinduro yangu? Iyo inoshanda kwauri. Munhu mumwe nomumwe akasiyana uye haagoni kupindura mishonga imwe chete.
Chikoro chimwe nechimwe chekudzivirira mwoyo chinoshanda pamakemikisi ako mune imwe nzira. Dr. Abbott Lee Granoff, nyanzvi mumunda wekutyisa chirwere uye kuora mwoyo, inotaura zvinotevera: "Kune mairi 23 anodzvinyirira 23 pamusika.
(Nhungamiro Inotungamirira: Nhamba iyi yakawedzerwa kubva kuna Dr. Granoff yakabvunzurudzwa munyaya ino.) Mumwe nomumwe anowedzera mamwe maurotransmitter muuropi uye mumwe nomumwe anogona kuita izvi mune zvikamu zvakasiyana zvakasiyana zveuropi. "Saka, kana mumwe munhu angawana zororo kubva iyo serotonin yavo inowedzera, imwe inogona kudikanwa nemishonga inobata zvose serotonin uye norepinephrin.Asi mumwe munhu angave achida rudzi rwakasiyana zvakasiyana rwemishonga, yakadaro anticonvulsant kana mafungiro emagadzirirwo akaita se lithiamu. Uyezve, munhu anoita zvakanaka pamishonga yakafanana Zoloft angasaita zvakare paProzac, kunyange zvazvo vose vari mukirasi imwechete.2 Munhu wese achave akasiyana chaizvo mukurapa kwavo.
Kungofanana nemhando dzakasiyana-siyana dzehutano, pane dzakasiyana-siyana zvezvinorwisa zvinodhaka. Zvakare, izvi zvinowira mumakirasi anotevera: monoamine oxidase inhibitors (MAOIs), tricyclics (TCA) uye sarotonin reuptake inhibitors (SSRIs).
Iko kunewo mishonga yakawanda mitsva iyo yakasiyana mune zvavanoita.
Monoamine Oxidase Inhibitors
Iyo monoamine oxidase inhibitors (MAOIs) yaive mamwe emishonga inotanga kuora mwoyo yakagadzirwa. Ivourotransmitters inokonzerwa nemafungiro, kunyanya norepinephrine uye serotonin, inozivikanwa se monoamines. Monoamine oxidase is enzyme inoputsa zvinhu izvi pasi. Monoamine oxidase inhibitors, sezvinoreva zita, inhibits enzyme iyi, nokudaro kubvumira kuwedzerwa kwemaikemikari aya kuti arambe aripo.
MAOI akange asingachafariri sezvinotanga kushandiswa kwekutanga-antidipressants nekuti anopa huwandu hwakaipa kune varwere kana achienzaniswa nemishonga mitsva. Zvichida kuurayiwa kwezvinodhaka-zvinodhaka zvinogona kuitika neMaOIs kana zvakabatanidzwa nemhando dzakasiyana dzemishonga inonzi serotonin agonists ("serotonin syndrome") kana norepinephrine agonists.3 Vanhu vari pamishonga iyi vanofanirawo kutevera zvidimbu zvekudya zvinowanikwa mu tyramine4 kudzivisa inogona kuwedzera huwandu hwehutano (high blood pressure) dambudziko. Chiitiko chakanyanya chakaipa chinowanikwa paMaoIs chete ndeye hypotension (kuderera kwemuviri weropa), iyo inogona kuratidza sekuneta uye inogona kutevedzera kuipa kwechikonzero chinonzi depression syndrome. Nokuda kwechikonzero ichi, kuwedzera kweropa kunofanirwa kuongororwa nguva dzose pavanoshandisa izvi zvinorwisa vanodzvinyirira.5
Tricyclics
Tricyclics, inozivikanwawo seheterocyclics, yakasvika mukushandiswa kukuru muma1950. Iyi mishonga inoita kuti musero wesero wekodha ishandise kudzorerazve serotonin uye norepinephrine, nokudaro kubvumira huwandu hwakawanda hwezvinhu zviviri izvi kuti huvepo huchishandiswa nemasero emagetsi.
Mukuwedzera pakuita norepinephrine uye serotonin, tricyclics inoratidza zvakafanana zvinokonzerwa ne histamine uye acetylcholine. Izvi ndizvo zvinokonzera zvinetso zvinotambudza zvinowanzotarisana nemishonga iyi, yakadai semuromo wakaoma, maonero akajeka, kuwedzera kuwanda uye sedation.6
Ne tricyclics, nhoroondo yezvechiremba yemurwere inofanira kunyatsoonekwa.
Iyi mishonga inogona kukonzera hutachiona hwehutano (chizuru kana chimiro chichimbomira, uye dzimwe nguva nemapapatendi uye zvinogona kukura mamiriro ezvinhu epfungwa) Varwere vane nhoroondo yekugumburwa kana kukuvara kwepamusoro vanofanirawo kungwarira sezvo mishonga iyi inogona kukuvadza.
Selective Serotonin Reuptake Inhibitors
Mitsva yekuderedza migumisiro yechirwere uye kuwedzera kukuchengetedza maererano nemishonga yakwegura yakaita chikwata ichi chekudzivirira mwoyo chinonyanyozivikanwa mumakore achangopfuura. Zvinodhaka zvepachikoro ichi zvinosanganisira fluoxetine (Prozac), citalopram (Celexa) escitalopram (Lexapro), fluvoxamine (Luvox), sertraline (Zoloft) uye paroxetine (Paxil).
SSRI inomirira Selective Serotonin Reuptake Inhibitor. Iyi mishonga inoshanda, sezvinoreva zita racho, nekudzivirira presynaptic serotonin mutakuri wevatori.8 Ichi chiremba chinopesana ne tricyclics mukuti chiito chayo chinonyatsojeka kune serotonin chete. Izvozvo zvinogadziriswa norepinephrine hazvisi pachena, kuburikidza nekuti kuwira serotonin "kunobvumira" norepinephrine kuwira sekuchengetedza serotonin kuchengetedza norepinephrine.9 SSRIs, kuburikidza nehuwandu hwavo, ine mukana wekusasvibisa histamine uye acetylcholine. Icho chirevo ndechekuti kunyange zvazvo vasina rutivi rwemigumisiro, havaiti mamiriro ekuvhiringidza akafanana nematricyclics.
Nzira Itsva
Mishonga mishanu mitsva iyo isingakodzeri kune zvataurwa pamusoro apa ndeyi: bupropion (Wellbutrin), nefazodone (Serzone), trazodone (Desyrel), venlafaxine (Effexor), uye mirtazapine (Remeron). Izvo zvinokonzerwa nepropropion's anti-depressant basa hazvinzwisisiki, asi inofungidzirwa kuti inopindirana kuburikidza ne noradrenergic kana dopaminergic migwagwa kana maviri maviri. Iyi mishonga haigoni kuita zvepabonde nemigumisiro yakajairika kune SSRIs uye inozivikanwa nevarwere vanoratidza kusava nesimba , kuisa pfungwa mupfungwa uye kurara zvakanyanya.
Nefazodone uye inonzi trazodone yayo inobvisa neuronal reuptake ye serotonin uye, kusvika zvishoma, norepinephrine. Vanodzivirirawo postsynaptic 5-HT2 receptors. Nefazodone ine ushamwari hwakashata hwecholingeric uye a1- adrenergic receptors uye, naizvozvo, inosanganiswa nechepasi sedation uye orthostasis kupfuura trazodone.11
Venlafaxine isimbi inoratidzika isingabatanidzi kune vamwe vanodzvinyirira.12 Sezvakaita maTCA, venlafaxine inhibits inotisal inogadzirwa yese serotonin uye norepinepherine. Venlafaxine ine-dose-dependent, inokonzerwa nemigumisiro pamapamupi ekusimudzira serotonin uye ipapo norepinephrine .. Pa 75 mg / zuva, venlafaxine inonyanya serotonin reuptake inhibitor (SRI) kufanana neSRRIs.
Pakubata 375 mg / zuva, inogadzira norepinephrine yakafanana nekudzivirira ku NSRI yakadai se desipramine.13
Mirtazapine ndiyo yakapedzisira kusunungurwa pane idzi ina uye ndiye wekutanga an2-antagonist akatengeswa seanorwisa mweya .4 Mirtazapine nenzira yakasiyana yekuita haisati inosanganisira enzyme inhibition kana kudzivirirwa kweeurotransmitter reuptake. Mirtazapine inowedzera kusunungurwa kwe norepinepherine kubva pakati pe noradrenergic neurons nekudzivirira presynaptic inhibitory alpha-2 autoreceptors. Iyo inobvisa alpha-1 postsynaptic receptor uye naizvozvo inowedzera mumutengo wokuwedzera noradrenergic kutumira. Sekuchengetedza kwechipiri presynaptic receptor block, mirtazapine inodzivirira alpha-2 heteroreceptors inhibitory iri pane serotonergic neurons, zvichiita kuti kuwedzere kusunungurwa kwe serotonin. Postsynaptically, mirtazapine ine hukama hwakaderera hwe 5-HT1A receptor, nokudaro kubvumira serotonin yakabudiswa muchibvumirano kuti isunge uye ichikurudzira ichi chinyorwa.
Zvisinei, inodzivirira postsynaptic 5-HT2 uye 5-HT3 receptors. Kukurudzirwa kwe-5-HT2 receptor inofungidzirwa kuti inokonzera serotonergic migumisiro yekusuruvara, kushungurudzika, uye kusagadzikana kwepabonde kunoonekwa ne SSRI uye 5-HT3 kukurudzira kugadziriswa kunofungidzirwa kurongedza kushungurudzwa kunoonekwa nevatariri.15, 16, 17 Nokudaro, mirtazapine's receptor kudzivirira purogiramu inodzivirira migumisiro yechiratidzo ichionekwa ne nonselective activation ye serotonin receptors inowanikwa ne clean reuptake blockers.